非ICU病房急性肾损伤患者行连续性肾脏替代治疗的时机选择  

Timing selection of continuous renal replacement therapy for patients with acute kidney injury in non-ICU department

作　　者：赵良玉 徐申 杨青青 司晓芸[1] ZHAO Liangyu;XU Shen;YANG Qingqing;SI Xiaoyun(Dept.of Nephrology,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院肾内科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2024年第1期74-79,共6页Medical Journal of Wuhan University

摘　　要：目的:探讨非重症监护室(non-ICU)病房急性肾损伤(AKI)患者进行连续性肾脏替代治疗(CRRT)的时机。方法:回顾性分析2013年至2017年武汉大学中南医院血液净化中心303例进行CRRT的AKI患者的临床资料,根据CRRT前24 h尿量是否小于0.5 mL/(kg·h)分为少尿组和非少尿组,记录两组进行CRRT治疗前后的指标改变。根据AKI患者CRRT后的肾功能恢复及30 d内死亡情况分组,分析治疗前后的指标改变,采用Logistic回归分析影响AKI患者肾功能恢复不良及30 d内死亡的独立危险因素。结果:少尿组患者行CRRT后肾功能未恢复率为42.1%,30 d内死亡率为23.7%,明显高于非少尿组(P<0.01)。多因素Logistic回归分析显示治疗前较高的APACHEⅡ评分、较少的24 h尿量和较高的脑钠肽(BNP)是AKI患者CRRT治疗后肾功能恢复不良的独立危险因素(P<0.05)。高龄、治疗前较少的24 h尿量、较高的APACHEⅡ评分和肾功能恢复不良为AKI患者30 d内死亡的独立危险因素(P<0.05)。结论:为改善非ICU病房内AKI患者的肾功能恢复情况,降低AKI患者的死亡率,应在较高的尿量和较低的APACHEⅡ评分时开始CRRT治疗。Objective:To investigate the timing of continuous renal replacement therapy(CRRT)for pa-tients with acute kidney injury(AKI)in a non-intensive care unit(non-ICU).Methods:The clinical da-ta of 303 AKI patients who underwent CRRT in the blood purification center of Zhongnan Hospital of Wuhan University from 2013 to 2017 were retrospectively analyzed.According to whether the 24-hour urine volume was less than 0.5 mL/(kg·h)before CRRT,they were divided into the oliguria group and non-oliguria group.The changes before and after CRRT were recorded.AKI patients were grouped according to renal function recovery and death within 30 days after treatment.The differences in various indicators were analyzed between the groups.Logistic regression was used to analyze the in-dependent risk factors for poor renal function recovery and death within 30 days in AKI patients.Results:The rate of poor renal function in the holiguria group after CRRT was 42.1%,and the mortality rate within 30 days was 23.7%,which was significantly higher than that in the non-oliguria group(P<0.01).Multivariate logistic regression analysis showed that higher APACHEⅡscore,less 24 h urine volume,and higher brain natriuretic peptide(BNP)before treatment were independent risk factors for poor renal function recovery in AKI patients(P<0.05).Advanced age,less 24 h urine volume,higher APACHEⅡscore before treatment,and poor renal function recovery were indepen-dent risk factors for death within 30 days in AKI patients(P<0.05).Conclusion:CRRT should be initiated at higher urine volume and lower APACHEⅡscore to improve renal function recovery and reduce mortality in patients with AKI in the non-ICU department.

关 键 词：连续性肾脏替代治疗 急性肾损伤 治疗时机 肾功能恢复 死亡率 

分 类 号：R692.6[医药卫生—泌尿科学]